8/23/20121(Maglaya, p. 169) The Community Health Nursing ProcessEDWIN O. BRACAMONTE, RN, MAN 2(Maglaya, p. 169)1. health status increased or decreased morbidity, mortality, fertility, or reduced capability for wellness2. health resources lack or absence of manpower, money, materials, or institution necessary to solve health problems3. health-related existence of social, economic, environmental, and political factors that aggravate illness-inducing situations in the communityEDWIN O. BRACAMONTE, RN, MAN 3(Maglaya, p. 169)1. heal th status increased or decreased morbidity, mortality, fertility, or reduced capability for wellness2. heal th resources lack or absence of manpower, money, materials, or institution necessary to solve health problems3. heal th acti on potenti al ability of the state and its people to address the health needs and problems of the community. It also mirrors the sensitivity of the government to the peoples struggle for better lives. (Maglaya, p. 162)EDWIN O. BRACAMONTE, RN, MAN 4(Maglaya, p. 158) A tool in determining the community health status A systematic approach / study of the health condition of a community, involving the collection, analysis and interpretation of data including statistical data The nurse COLLECTSdata about the community in order to identify the different factors that may directly or indirectly influence the health of the population. Then she proceeds to ANALYZE and seek explanations for the occurrence of health needs and problems of the community. The community health NURSING DIAGNOSES are then derived and will become the bases for DEVELOPINGand IMPLEMENTINGcommunity health nursing i nterventi ons and strategies. This process is called community diagnosis. Others call it community assessment or situational analysis.EDWIN O. BRACAMONTE, RN, MAN 5(Maglaya, p. 158) The health status of the community is the product of the various interacting elements such as population, the physical and topographical characteristics, socio-economic and cultural factors, health and basic social services and power structure within the community. EDWIN O. BRACAMONTE, RN, MAN 68/23/20122(Maglaya, p. 159)a. Comprehensi ve Aims to obtain general information about the community (e.g., assessment of specific population group in the community)b. Problem oriented or focused A type of assessment that responds to a particular need (e.g., disaster situation or an outbreak of disease)EDWIN O. BRACAMONTE, RN, MAN 7(Maglaya, p. 159)a. Demographic Variables - show size, composition and geographic distribution of the population1. Total population and geographical distribution including urban-rural index and population density2. Age and sex composition3. Selected vital indicators such as growth rate, crude birth rate, crude death rate and life expectancy at birth4. Patterns of migration5. Population projection It is also important to know whether there are population groups that need special attention such as indigenous people, internal refugees, and other socially dislocated groups as a result of disaster, calamities and development programsEDWIN O. BRACAMONTE, RN, MAN 8(Maglaya, p. 159)b. Socio-Economic and Cultural Variables1. Social indicatorsa.Communication network (formal or informal channels) necessary for disseminating health information or facilitating referral of a client to the health care systemb.Transportation system including road networks necessary for accessibility of the people to the health care delivery systemc.Educational level which may be indicative of poverty and may reflect on health perception and utilization pattern of the communityd.Housing conditions which may suggest health hazards (congestion, fire, exposure to elements)EDWIN O. BRACAMONTE, RN, MAN 9(Maglaya, p. 159)2. Economic indicatorsa.Poverty level incomeb.Unemployment and underemployment ratesc.Proportion of salaried and wage earners to total economically active populationd.Types of industry present in the communitye.Occupation common in the community EDWIN O. BRACAMONTE, RN, MAN 10(Maglaya, p. 159)3. Environmental indicatorsa.Physical/geographical/topographical characteristics of the community land areas that contribute to vector problems (dengue, malaria etc) terrain characteristics that contribute to accidents or pose geohazard zones land usage in industry climate/seasonb.Water supply % population with access to safe, adequate water supply Source of water supplyEDWIN O. BRACAMONTE, RN, MAN 11(Maglaya, p. 159)c.Waste disposal % population served by daily garbage collection system % population with safe excreta disposal system types of waste disposal and garbage disposal systemd.Air, water and land pollution industries within the community having health hazards associated with it air and water pollution indexEDWIN O. BRACAMONTE, RN, MAN 128/23/20123(Maglaya, p. 159)4. Cultural factorsa.Variables that may break up the people into groups within the community such as: ethnicity social class language religion race political orientation b.Cultural beliefs and practices that affect health (beliefs regarding causes of sickness and health)c.Concepts about health and illnessEDWIN O. BRACAMONTE, RN, MAN 13(Maglaya, p. 159)c. Health and Illness Patterns Can be gathered through primary or reliable and updated secondary sources1. Leading causes of Mortality2. Leading causes of Morbidity3. Leading causes of Infant Mortality4. Leading causes of Maternal Mortality5. Leading causes of Hospital AdmissionEDWIN O. BRACAMONTE, RN, MAN 14(Maglaya, p. 159)d. Heal th Resources1. Manpower Resources categories of health manpower available geographical distribution of health manpower manpower-population ratio distribution of health manpower according to health facilities (hospitals, rural health units, etc) distribution of health manpower according to type of organization (government, non-government, health units, private) quality of health manpower Existing manpower development/policiesEDWIN O. BRACAMONTE, RN, MAN 15(Maglaya, p. 159)2. Material resources health budget and expenditures sources of health funding categories of health institutions available in the community hospital bed-population ratio categories of health services availableEDWIN O. BRACAMONTE, RN, MAN 16(Maglaya, p. 159)e. Political/Leadershi p Patterns1. Power structures formal and informal (community organization, government structures)2. Attitudes of people towards the authority3. Conditions/events/issues that cause social conflict/upheavals that lead to social bonding or unification4. Practices/approaches that are effective in settling issues and concerns within the communityEDWIN O. BRACAMONTE, RN, MAN 17(Maglaya, p. 163) The process of community diagnosis consists of col l ecti ng, organi zi ng, synthesi zi ng, anal yzi ng and i nterpreti ng health data. Before she collects the data, the objectives must be determined by the nurse as these will dictate the depth or scope of the community diagnosis. She needs to resolve whether a comprehensive or problem-oriented community diagnosis will accomplish her objectives.EDWIN O. BRACAMONTE, RN, MAN 188/23/20124(Maglaya, p. 163)1. Determine objectives2. Define the study population 3. Determine the data to be collected4. Collect the data5. Develop the instrument6. Actual data gathering7. Data Collation8. Data Presentation9. Data Analysis10. Identifying the Community Health Nursing Problems11. Priority-SettingEDWIN O. BRACAMONTE, RN MAN 19 Decides on the depth and scope of the data needed to be gathered Comprehensive or problem-oriented Identify the population group included in the studyEDWIN O. BRACAMONTE, RN MAN 20 Identify the specific data to be collected Decide on the sources of data Different methods may be utilized to generate health data The nurse decides on specific methods depending on the type of data to be generatedEDWIN O. BRACAMONTE, RN MAN 21 Primary data Obtained first hand by the investigator Secondary data Those which is existing and obtained by other people Records review Surveys and observations (e.g., ocular surveys) Interviews (e.g., key informant interview, individual and group interview) Participant observationEDWIN O. BRACAMONTE, RN MAN 22 Explain purpose for collecting the data Ask appropriate questions Use words / language on level of understanding Clarify technical terms Establish eye contact Validate / clarify the information obtained Be tactful / courteous Utilize transitional statements Express appreciation Document factually Use proper time managementEDWIN O. BRACAMONTE, RN MAN 23 Use of spot map in planning Use of campaign / posters Coordinate with barangay officials Maximize resources, time, and manpower Use markers or stickers in labeling households Target number of households/quota in relation to available time EDWIN O. BRACAMONTE, RN MAN 248/23/20125 Spot map should be oriented to the North. Geographical boundaries correctly identified. Households should be numbered according to the control number in the survey tool for easy reference, case finding, and contact tracing. Roads, bridges, arcs (if present) included in the map. Significant landmarks and institutional facilities (health center, brgy hall, church, hospitals, market, talipapa, recreational facilities, water district, municipal hall, schools, etc) included in the map. Topography (mountains, bodies of water, etc., if present) included in the map.EDWIN O. BRACAMONTE, RN, MAN 25 Provide legends for easy reference. Legends should be simple and easy to recognize. Important landmarks/facilities should be labeled with their actual names, not just as school or street, for example. Distances among households, facilities, roads, etc should be realistic and proportioned to establish areas of congestion or proximity. Areas that contribute to vector problems and terrain characteristics that pose hazards properly identified. Promptly submits the final version of the spot map.EDWIN O. BRACAMONTE, RN, MAN 26EDWIN O. BRACAMONTE, RN, MAN 27 Instruments or tools facilitate the nurses data-gathering activities. Instruments used Survey Questionnaire Interview Guide Observation Checklist EDWIN O. BRACAMONTE, RN MAN 28 Meet the people who will be involved in data collection The instruments are discussed, analyzed, and modified or simplified so as not to overburden the people Pre-testing of the instrument is highly recommended Orientation and training on how to use the instrument (Role Play) Checking for completeness, accuracy, and reliability of information collected.EDWIN O. BRACAMONTE, RN MAN 29 After data collection, the nurse is now ready to put together all the information Types of data Numerical Data which can be counted Descriptive Data which can be describedEDWIN O. BRACAMONTE, RN MAN 308/23/20126 Mutually exclusive choices do not overlapTo cl assi fy sex: MALEFEMALETo cl assi fy monthl y i ncome:Bel ow P 500P 501-1000P 1001-1500P 1501-2000EDWIN O. BRACAMONTE, RN MAN 31 Mutual l y exhausti ve anticipates all possible answersFamily Planning Methods:Lactational Amenorrhea MethodNatural Basal Body Temperature Cervical Mucus Method Sympthothermal Method Standard Days Method Others (specify):Artificial IUDs Pills Injectables Condoms Others (specify)Permanent Tubal Ligation VasectomyEDWIN O. BRACAMONTE, RN MAN 32 Open-ended questions do not provide choices or categories but the health care provider can still facilitate data collation by constructing categories.Question: Bakit hindi kayo nagpapasuso ng inyong sanggol?Response 10: Bawal sa akin, sabi ng doctor.Response 27: Nagtatrabaho ako.Response 30: Ayaw ni Mister.Response 45: Masakit.Response 59: Masisiraang figure ko.Response 60: Medical reasonsResponse 62: May sakit ako.Response 67: Modern at convenient angformula feeding.Response 75: Pagod na ako pagkagaling satrabaho.Response 77: Mas gusto ko ang magpasuso sabote.For these responses, possible categories are:Convenience- Responses 67, 77Medical reasons- Responses 10, 60, 62Personal reasons- Responses 30, 45, 59Economic/work reasons- Responses 27, 75EDWIN O. BRACAMONTE, RN MAN 33 Manual l y using tally sheetsDi seases Tal l y Mark FrequencyParasitism IIIII-IIIII-IIIII-IIIII 20Diarrhea IIIII-IIIII-IIIII-II 17Cough IIIII-IIIII-IIIII-IIIII-IIIII-IIIII-III33EDWIN O. BRACAMONTE, RN MAN 34 Usi ng computer using numbers and codesSex Male 4Female 6Rel i gi on Catholic 1INK 2Methodist 3Aglipayan 3EDWIN O. BRACAMONTE, RN MAN 35 Depends on the type of data obtained1. Descriptive dataPresented in narrative forms (geography, history, beliefs about illness)2. Numerical dataPresented into tables and graphs. Provide ease in comparison including patterns and trends.EDWIN O. BRACAMONTE, RN MAN 368/23/20127EDWIN O. BRACAMONTE, RN MAN 37 Types of Graphs Line Graph Bar Graph/Pictograph Histogram or frequency polygon Pie chart or proportional/component bar graph Proportionate bar graph Scattered diagram Tabular presentationEDWIN O. BRACAMONTE, RN MAN 38Type of Graph Data Functi onLi ne graph shows trend or changes with time or ageBar graph or pi ctograph absolute or relative counts / rates between categories represented by bars or rectangles whose heights or lengths are proportionate to their values and stand as the basis for comparison should have equal width and gaps maybe drawn horizontally or verticallyHi stogram or frequency pol ygon shows frequency distribution or measurement depicts counts, of each class or grouping distribution is continuous no gaps or spacesType of Graph Data Functi onPi e chart or proporti onal /component bar graph breakdown when number of categories are too many show how a whole is divided portion of the slice is proportionate the whole pieProporti onate bar graph bar is divided into smaller rectangles representing parts used for comparison between groups that are comparedScattered di agram shows correlation of variablesTabul ar presentati on easily point out trends, comparison, interrelationships among variablesEDWIN O. BRACAMONTE, RN MAN 39 Establish trends and patterns in terms of health needs and problems of the community Comparison to standard values Interrelationship of factors will help the nurse view the significance of the problem and implications on the health status of the communityEDWIN O. BRACAMONTE, RN MAN 40EDWIN O. BRACAMONTE, RN, MAN 41Water StorageThis refers to containers used by thefamilies for water storage. The containersused were observed whether they arecovered or uncovered. Uncovered watercontainers could play a significant role inthe occurrence of vector and water bornediseasesEDWIN O. BRACAMONTE, RN, MAN 428/23/20128WATER STORAGEDefinition:Water storage deals with the manner in which water iskept. It can either be in a covered or uncovered container.Significance:Water-related diseases are the most common causeof illness and death. Households which utilize proper storageof water would suffer less morbidity and mortality fromwater-related diseases. It is significant as it has something to dowith how water is being kept and the occurrence of vectorandwater borne diseasesMethodology:The method used in collecting data is throughcommunitysurveyEDWIN O. BRACAMONTE, RN, MAN 43Tabl e No. 1 Frequency and Percentage Di stri buti on of the Storage of Dri nki ng Water of the Surveyed Fami l i es i n Barangay FEU, Mani l a Ci ty as of August 2012EDWIN O. BRACAMONTE, RN MAN 44Variables Frequency PercentageCovered 250 55.56%Uncovered 200 44.44%TOTAL 450 100.00%Fi gure No.1 Percentage Di stri buti on of the Storage of Dri nki ng Water of the Surveyed Fami l i es i n BarangayFEU, Mani l a Ci ty as of August 2012EDWIN O. BRACAMONTE, RN MAN 4544.44%55.56%CoveredUncoveredInterpretati on:There were 56% or 250 families that have covered watercontainers. On the other hand, 44% or 200 families were found to haveuncovered water containersAnal ysi s:This is primarily because of the low educational attainment ofcommunity people that consequently lead to having limited knowledge onthe nature of vector and water borne diseases that was based on the FGDconducted. Inadequate knowledge about the magnitude of the problemputs the residents at risk of developing such diseases. (Bonjing andManoling 2007)Heal th Impl i cati on:Uncovered water containers can lead to different water and vectorborne diseases. Diarrhea, which is one of them, was found to be ranked 3as the leading causes of morbidity in the community. In the country,diarrhea is ranked 5 as the leading causes of infant mortality and ranked10 as the leading causes of adult morbidity (Fundamentals of Nursing,Kozier, p 171, 2008).EDWIN O. BRACAMONTE, RN, MAN 461. Health status problems2. Health resources problems3. Health-related problemsUse of Problem Trees in explaining and describing the health problem/s (cause and effect)EDWIN O. BRACAMONTE, RN MAN 47(Maglaya, p. 170) Prioritizing which problems to address first, considering the resources available at the moment Cri teri a for pri ori ty-settinga. Nature of the problem The problems are classified as health status, health resources or health-relatedb. Magnitude of the problem Refers to the severity of the problemwhich can be measured in terms of proportion of the population affected by the problemc. Modifiabil it y of the problem Refers to the probability of reducing, controlling or eradicating the problemd. Preventive potential Refers to the probability of controlling or reducing the effects posed by the probleme. Social concern Refers to the perception of the population or the community as they are affected by the problemand their readiness to act on the problemEDWIN O. BRACAMONTE, RN, MAN 488/23/20129(Maglaya, p. 170)Criteria WeightNature of the problem 1Health status 3Health resources 2Health-related 1Magnitude of the problem 375% - 100% affected 450% - 74% affected 325% - 49% affected 2